Key Takeaway
Learn about staged accident fraud in NY no-fault insurance cases. Court analysis of intentional collision factors including policy age, inconsistent testimony, and party relationships.
This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
State Farm Mut. Auto. Ins. Co. v Pace, 2022 NY Slip Op 30391(U)(Sup. Ct. Kings Co. 2022)
“With regard to State Farm’s first, second, and third causes of action, parties generally are not entitled to recover no-fault benefits for damages resulting from intentional events (Matter of Allstate Ins. Co. v Massre, 14 AD3d 610, 61 I , citing State Farm Mut. Auto. Ins. Co. v Laguerre, 305 AD2d 490, 490-91 ). When determining if a collision was intentional, the court looks to circumstantial factors. Common considerations include the age of the policy at the time of the loss, the value and age of the car involved, cancellation of the policy shortly thereafter, interrelationships among the parties involved, inconsistencies in testimony regarding the circumstances of the subject collision, and inconsistencies in the identities of the individuals involved.
(PDG Psychological, P.C. v Stale Farm Ins. Co., 12 Misc 3d 1183, 2006 NY Slip Op 51398 *6 ; VS. Med. Services, P.C. v Allstate Ins. Co., 11 Misc 3d 334, 343 ; Matter of Progressive County Mut. ins. Co. by McNeil, 4 Misc 3d 1022, 2004 NY Slip Op 50998, *2 )
Ms. Rivera states in her affidavit that the policy was thirty-three days old, and provides a copy of the subject policy (Rivera affirmation at ,i 16). Ms. Rivera also notes in her affidavit the following testimony from the EUOs of Ms. Conway and Ms. Chandler: Ms. Conway claims to have known all occupants of the vehicle for several years prior to the accident (Conway EUO at 32). Conversely, Ms. Chandler denies having known any of them until the day of the crash (Chandler EUO at 13 ).
Ms. Conway claims the group had planned to go to the theater on Court Street that night, but they had not picked a movie, did not know the show times, and did not know that the theater would be closed by the time they arrived (Conway EUO at 18-20). Ms. Conway claims the group had not seen or spoken to each other for three months prior to the day of the crash (Conway EUO at 32).
Ms. Conway claims the accident occurred in the roundabout on Grand Army Plaza (Conway EUO at 21 ). Ms. Chandler, however, denies the accident occurred in the roundabout (Chandler EUO at 22). Ms. Conway claims the car was moved to a service lane immediately following the collision (Conway EUO at 26. Ms. Chandler claims the car remained in the street immediately following the collision (Chandler EUO at 24). Accordingly, State Farm has sufficiently established the facts of its first, second, and third causes of action”
New policy, inconsistent statements. Fraud.
Related Articles
Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
Keep Reading
More No-Fault Analysis
Priority of Payment Regulation Has No Force in Arbitration: First and Second Departments Agree
Both the First and Second Departments have held that the priority of payment regulation under 11 NYCRR 65-3.15 is of no force or effect in no-fault arbitration proceedings....
Feb 25, 2026How Insurance Companies Use Colossus Software to Undervalue Your Injury Claim
Insurance companies use Colossus software to lowball your injury claim. Learn how this system works and how a Long Island attorney can fight back. Call 516-750-0595.
Feb 18, 2026A medical necessity a** beating
Court ruling on no-fault insurance benefits case where plaintiff successfully obtained summary judgment for unpaid medical bills totaling $44,573.86.
Jul 7, 2022New judges at the Appellate Division
Personal injury attorney Jason Tenenbaum shares his insights on new Appellate Division judges, including Justice LaSalle and Justice Higgitt's promotions.
May 26, 2021Corporate v. individual
New York appellate court reinforces the long-standing rule that corporate officers must sign contracts individually to assume personal liability for business obligations.
Dec 4, 2015The magic bus
Cuomo v Ferran case explores mobile dental treatment fraud and no-fault insurance implications involving converted Greyhound buses used as mobile dentist offices in New York.
Oct 17, 2010Common Questions
Frequently Asked Questions
What is New York's no-fault insurance system?
New York's no-fault insurance system, codified in Insurance Law Article 51, requires all drivers to carry Personal Injury Protection (PIP) coverage. This pays for medical expenses, lost wages (up to $2,000/month), and other basic economic loss regardless of who caused the accident, up to $50,000 per person. However, to sue for pain and suffering, you must meet the 'serious injury' threshold under Insurance Law §5102(d).
How do I fight a no-fault insurance claim denial?
When a no-fault claim is denied, you can challenge it through mandatory arbitration under the American Arbitration Association's no-fault rules, or by filing a lawsuit in court. Common defenses to denials include challenging the timeliness of the denial, the adequacy of the peer review report, or the insurer's compliance with regulatory requirements. An experienced no-fault attorney can evaluate which strategy gives you the best chance of overturning the denial.
What is the deadline to file a no-fault claim in New York?
Under 11 NYCRR §65-1.1, you must submit a no-fault application (NF-2 form) within 30 days of the accident. Medical providers must submit claims within 45 days of treatment. Missing these deadlines can result in claim denial, though there are limited exceptions for late notice if the claimant can demonstrate a reasonable justification.
What no-fault benefits am I entitled to after a car accident in New York?
Under Insurance Law §5102(b), no-fault PIP covers necessary medical expenses, 80% of lost earnings up to $2,000/month, up to $25/day for other reasonable expenses, and a $2,000 death benefit. These benefits are available regardless of fault, up to the $50,000 policy limit. Claims are paid by your own insurer — not the at-fault driver's.
Can I choose my own doctor for no-fault treatment in New York?
Yes. Under New York's no-fault regulations, you have the right to choose your own physician, chiropractor, physical therapist, or other licensed healthcare provider. The insurer cannot dictate which providers you see. However, the insurer can request an IME with their chosen doctor and may challenge the medical necessity of your treatment through peer review.
Was this article helpful?
About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a no-fault matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.